What's the right time for replacement surgery?

Snowshoe

Joint replacement is one of the most common elective procedures in the United States today. And with good reason.


Joint replacements hold the promise of significant pain reduction and improved mobility. In healthy individuals procedures can be performed on an outpatient basis or require just a single-night stay at the hospital. In addition, significant advancements in surgical techniques as well as in the design of devices have added to the appeal of the procedure.


For example, in the past, replacement devices had a lifespan of about 10 years. For that reason, many people put off surgery and lived with frequently intense and limiting pain for as long as possible, often until they were in their 70s. They would put their active lifestyle on hold while they waited to age into surgery, missing out on active years and often falling out of shape during a time when they could have been maintaining a healthy and strong body as they aged.


But thanks to new materials and engineering, today’s replacement hips and knees last for 20, and even up to 30, years. With severe arthritis changes these procedures might be appropriate for patients in their 50s and 60s. The goal is to maintain an active lifestyle and to do the things you love.


That said, joint replacement is not a first-line treatment option. It is still major surgery and, as good as the technology and engineering are today, a replacement device is just that: a replacement. It will never feel exactly the way your original joint did.


Given that, I always encourage patients to exhaust all other treatment options before considering surgery. Options might include:

  • Weight loss lessens the pressure put on joints, especially knees and hips, and can go a long way toward reducing pain.
  • Icing or heat to the painful joint as needed for pain or after activity.
  • Oral and topical anti-inflammatory medications to reduce pain, swelling, and stiffness.
  • Modified activities can reduce aggravation or cut down repetitive strain on a troublesome joint and provide relief.
  • Injections, including cortisone, can offer pain relief and reduce inflammation. If cortisone is not working, then hyaluronic acid injections, which work by lubricating joints, may improve mobility and reduce pain.

If those therapies don’t work and you find that pain is preventing you from leading the life you want, then it may be time to consider joint replacement.


Michaela Schneiderbauer, MD, is an orthopedic surgeon at SVMC Orthopedics in Bennington, VT. She also sees patients at SVMC Northshire in Manchester, VT.